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Category: Volume 07 Issue 05 May 2019
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Title: Comparative Study of Oral versus Inhaled Steroid in the Treatment of Patients, Suffering From Moderate Asthma Attending in Tertiary Care Hospital at Muzaffarpur, Bihar

Authors: Dr Ashish Ranjan, Dr Deepak Kumar

 DOI: https://dx.doi.org/10.18535/jmscr/v7i5.55

Abstract

Objective: Present study was conducted to evaluate the effect of high doses of inhaled steroid fluticasone in comparison with oral steroid prednisone in adult patients suffering from moderate asthma exacerbations.

Materials and Methods: A total of 60 Patients of either sex, aged between 28 and 56 with moderate asthma exacerbations were included in the study. All the patients were randomized in two study Groups. Group A included 30 patients, Group B also contains 30 patients. Group A patients received fluticasone via a metered-dose inhaler and spacer 16 puffs (4,000 μg/day) and Patients in Group B receive one pill prednisone 30 mg/day. All the patients undergone Spirometry and CBC before treatment and after 2, 6 and 24 hour of treatment.

Result: Symptoms clearly improved in all the patients in both the study groups after 24 hours. There were no any differences recorded between the both study groups in peak expiratory flow or forced expiratory flow in one second, which improved progressively but then delayed slightly after 24 hours. Eosinophil counts were also improved. The patients improve faster with fluticasone treatment than with prednisone, but effect was same after 24 hours.

Conclusion: both treatments improved symptoms, airway obstruction and inflammation, and CBC at 24 hour. Prednisone and fluticasone reduced blood and sputum eosinophil counts, shows anti inflammatory effect of fluticasone are exerted locally.

References

  1. National Heart, Lung and Blood Institute/World Health Organization. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. National Institutes of Health. Publication No. 02-3659. Bethesda, National Heart, Lung, and Blood Institute; 2002
  2. Rodrigo G, Rodrigo C. Corticosteroids in the emergency department therapy of acute adult asthma: an evidence-based evaluation. Chest1999;116:285–295.
  3. Stein LM, Cole RP. Early administration of corticosteroids in emergency room treatment of acute asthma. Thorax 1992;47:588–591.
  4. Barnes PJ, Pedersen S, Busse WW. Efficacy and safety of inhaled corticosteroids. New developments. Am J Respir Crit Care Med1998;157: Suppl. 3 S1–S53.
  5. Edmonds ML, Camargo CA Jr, Pollack CV Jr, et al.Early use of inhaled corticosteroids in the emergency department treatment of acute asthma. Cochrane Database Syst Rev 2003;3:CD002308
  6. Rowe BH, Edmonds ML, Spooner CH, et al.Corticosteroid therapy for acute asthma. Respir Med2004;98:275–284.
  7. Harrison TW, Oborne J, Newton S, et al.Doubling the dose of inhaled corticosteroid to prevent asthma exacerbations: randomised controlled trial. Lancet 2004;363:271–275.
  8. Edmonds ML, Camargo CA, Saunders LD, et al.Inhaled steroids in acute asthma following emergency department discharge. Cochrane Database Syst Rev 2000;3:CD002316
  9. Rodrigo G, Rodrigo C. Inhaled flunisolide for acute severe asthma. Am J Respir Crit Care Med1998;157:698–703.
  10. Rodrigo GJ, Rodrigo C. Triple inhaled drug protocol for the treatment of acute severe asthma. Chest2003;123:1908–1915.
  11. Lee-Wong M, Dayrit FM, Kohli AR, et al.Comparison of high-dose inhaled flunisolide to systemic corticosteroids in severe adult asthma. Chest 2002;122:1208–1213.
  12. Guttman A, Afilalo M, Colacone A, et al.The effects of combined intravenous and inhaled steroids (beclomethasone dipropionate) for the emergency treatment of acute asthma. The Asthma ED Study Group.Acad Emerg Med 1997;4:100–106.
  13. Levy ML, Stevenson C, Maslen T. Comparison of short courses of oral prednisolone and fluticasone propionate in the treatment of adults with acute exacerbations of asthma in primary care. Thorax1996;51:1087–1092.
  14. Rodrigo GJ. Comparison of inhaled fluticasone with intravenous hydrocortisone in the treatment of adult acute asthma. Am J Respir Crit Care Med2005;171:1231–1236.
  15. McFadden ER Jr. Inhaled glucocorticoids and acute asthma: therapeutic breakthrough or nonspecific effect?.Am J Respir Crit Care Med1998;157:677–678.
  16. Hill MR, Szefler SJ, Ball BD, et al.Monitoring glucocorticoid therapy: a pharmacokinetic approach. Clin Pharmacol Ther 1990;48:390–398.
  17. Laitinen LA, Laitinen A, Heino M, et al.Eosinophilic airway inflammation during exacerbation of asthma and its treatment with inhaled corticosteroid. Am Rev Respir Dis 1991;143:423–427.
  18. Oh JW, Lee HB, Kim CR, et al.Analysis of induced sputum to examine the effects of inhaled corticosteroid on airway inflammation in children with asthma. Ann Allergy Asthma Immunol 1999;82:491–496.

Corresponding Author

Dr Ashish Ranjan

Tutor, Department of Pharmacology, Sri Krishna Medical College, Muzaffarpur, India